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"Seorang ibu primigravida berumur 20 tahun hamil 38 minggu dengan komplikasi tumor uterus intraligamenter kiri yang besar dan padat. Operasi dimulai dengan seksio sesarea untuk melahirkan bayi. Diberikan uterotonika intramural dan kontraksi uterus baik; diberikan infus oksitosin intra dan postoperatif selama 24 jam. Teknik jahitan ?double circle? dilakukan pada bagian lateral mioma sebelum miomektomi. Tidak diberikan transfusi darah. Histopatologinya adalah leiomioma. Pasien tersebut pulang dalam keadaan sehat 4 hari setelah operasi. (Med J Indones 2004; 13: 66-8)

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A 20-year-old primigravida with 38th weeks of gestation complicated with a left large solid intraligamentous uterine tumor. The operation started with lower segment cesarean section to delivere the fetus. Intramural uterotonica was given and the uterus contracted well; intra- and up to 24 hours post-operatively oxytocin infusion was administered. Double circle stitching technique was performed on lateral side of the mioma before starting myomectomy. No blood transfusion was given. The histopatological report was leiomyoma. She was discharged in healthy condition 4 days post-operatively. (Med J Indones 2004; 13: 66-8)"

"Tulisan ini membahas dan melaporkan ruptura uteri saat kehamilan dan persalinan pada kasus pasca miomektomi perlaparoskopi. Laporan kasus kejadian ruptur uterus pada pasien yang sebelumnya mengalami laparoskopi operatif miomektomi miom intramural Æ 3.5 cm, yang 6 bulan kemudian mengalami kehamilan. Tidak ada gejala ke arah ruptura uteri saat kehamilan namun pada saat usia gestasi 34 minggu, pasien mengalami gejala ruptura uteri. Pada saat laparotomi; ditemukan fetus 2100 gram mati, dan robekan jaringan 5 cm pada sikatriks bekas miomektomi. Pada pasien yang mengalami miomektomi per laparoskopi khususnya miom intramural mempunyai risiko ruptura uteri pada saat persalinan. (Med J Indones 2004; 14: 113-6)

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Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature. Case report of uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 6 months after an 3.5 cm intramural myoma, had been laparoscopically removed. No symptoms suggesting uterine rupture were observed during the pregnancy, but in the first stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of 2100 gr fresh dead fetus in the abdominal cavity and ruptured uterine muscle in the scarred area about 5 cm. In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine rupture at delivery. This is also the case where unappropriate suturing of the uterine muscle had been required. (Med J Indones 2004; 14: 113-6)"

"Dengan kemajuan dalam bidang kedokteran yang terus menerus melakukan peningkatan perbaikan layanan demi kepuasan dan keselamatan pasien yang lebih baik. ERACS (Enhanced Recovery After Cesarean Section) merupakan suatu kemajuan dalam layanan kedokteran terutama dalam bidang obstetric, dimana pendekatan multimodal dalam persiapan pre operasi, intra operasi, dan juga pasca operasi. ERACS merupakan kolaborasi multidisplin yang sangat menentukan keberhasilan luaran dari ERACS, kolaborasi anatar dokter spesialis obgyn, dokter spesialis anastesi, perawat/bidan, dan juga pasien itu sendiri. ERACS juga telah dilaksakan di RSIA Kemang Medical Care sejak November 2021 dan masih menjadi pilihan layanan untuk pasien yang akan melahirkan secara operasi terencana/elektif sampai dengan saat ini. Untuk itu dalam upaya untuk menjamin mutu pelayanan di RSIA Kemang Medical Care, maka perlu untuk mengukur efektivitas (length of stay, nyeri, dan biaya) dari penerapan protocol ERACS di RSIA Kemang Medical Care tahun 2022. Penelitian ini menggunakan pendekatan studi kuantitatif cross sectional. Dimana data yang diambil merupakan data sekunder untuk melihat kepatuhan penerapan protocol ERACS yang dilihat berdasarkan daftar tilik ERACS RSIA Kemang Medical Care. Selain itu juga melihat kepatuhan masing-masing tenaga kesehatan yang terlibat begitu juga dengan kepatuhan pasien yang menjalankan proyokol ERACS. Wawancara dilakukan kepada beberapa pihak manajemen sebagai pemangku kebijakan untuk memperkuat hasil penelitian. Berdasarkan hasil analisis statistik, dinyatakan bahwa terdapat hubungan yang signifikan (p value 0,04) antara kepatuhan penerapan protocol ERACS terhadap efektivitas ERACS di RSIA Kemang Medical Care. Dimana setiap kepatuhan penerapan protocol ERACS akan berpengaruh sebesar 8 kali terhadap efektivitas ERACS di RSIA Kemang Medical Care pada tahun 2022.

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With advances in the medical field, we are continuously improving services for better patient satisfaction and safety. ERACS (Enhanced Recovery After Cesarean Section) is an advancement in medical services, especially in the field of obstetrics, where there is a multimodal approach in pre-operative, intra-operative and also post-operative preparation. ERACS is a multidisciplinary collaboration that really determines the success of ERACS outcomes, collaboration between ob-gyn specialists, anesthesiologists, nurses/midwives, and also the patients themselves. ERACS has also been carried out at RSIA Kemang Medical Care since November 2021 and is still the service of choice for patients who are going to give birth via planned/elective surgery until now. For this reason, in an effort to guarantee the quality of service at RSIA Kemang Medical Care, it is necessary to measure the effectiveness (length of stay, pain and costs) of implementing the ERACS protocol at RSIA Kemang Medical Care in 2022.

This research uses a quantitative cross sectional study approach. Where the data taken is secondary data to see compliance with the implementation of the ERACS protocol which is seen based on the RSIA Kemang Medical Care ERACS checklist. Apart from that, it also looks at the compliance of each health worker involved as well as the compliance of patients who carry out the ERACS procedure. Interviews were conducted with several management parties as policy makers to strengthen the research results. Based on the results of statistical analysis, it was stated that there was a significant relationship (p value 0.04) between compliance with the implementation of the ERACS protocol and the effectiveness of ERACS at RSIA Kemang Medical Care. Where every compliance with the implementation of the ERACS protocol will have an impact of 8 times on the effectiveness of ERACS at RSIA Kemang Medical Care in 2022"

"Latar Belakang: Penyuntikan obat anestesia spinal dosis tunggal diketahui menyebabkan hipotensi yang lebih besar dibandingkan dosis terbagi pada pasien obstetrik sehat, namun belum ada penelitian yang dilakukan pada pasien obsterik dengan penyulit hipertensi, khususnya di Indonesia. Hipotensi akibat anestesia spinal, khususnya pada pasien obstetrik dengan penyulit hipertensi, akan mengganggu kesejahteraan ibu dan janin. Tujuan: Membandingkan penurunan MAP dan kebutuhan efedrin, serta mengetahui level ketinggian blok antara teknik anestesia spinal dosis terbagi dengan dosis tunggal untuk bedah Sesar dengan penyulit hipertensi. Metode. Uji klinis acak tersamar tunggal terhadap 42 pasien di RSU Kabupaten Tangerang yang memenuhi kriteria dibagi menjadi dua kelompok. Kelompok dosis terbagi (TB) dilakukan dengan menyuntikkan 2/3 dosis (1,5 ml), dilanjutkan 1/3 dosis sisanya (1 ml) setelah jeda 90 detik. Kelompok dosis tunggal (TU) dilakukan dengan menyuntikkan seluruh dosis dalam sekali bolus. Keduanya dilakukan dalam posisi duduk, menggunakan kombinasi obat anestesia spinal bupivakain 0,5% hiperbarik 10 mg dan fentanil 25 mcg (volume total 2,5 ml), kecepatan 0,2 ml/detik, barbotase £0,1 ml sebelum penyuntikan, serta pemberian coloading cairan kristaloid 5-10 ml/KgBB. MAP diukur sebanyak 7 kali, dan kebutuhan efedrin serta ketinggian blok dicatat. Analisis hasil menggunakan uji General Linear Model (GLM) untuk pengukuran berulang, uji Fisher dan Mann-Whitney U. Hasil: Uji GLM menunjukkan tidak ada perbedaan bermakna antar waktu pengukuran antar kelompok (P >0,05), namun grafik garis menunjukkan trend MAP kelompok TB lebih tinggi pada 3 menit pertama dibandingkan kelompok TU. Penurunan MAP >20% terjadi lebih cepat pada kelompok TU (menit ke-3). Ketinggian blok sensorik keduanya terbanyak pada level T4 sebesar 11 subjek (52,4%) pada kelompok TB dan 9 subjek (42,9%) pada kelompok TU (P=0,59). Perbandingan dosis total pemakaian efedrin mendapat nilai median (range) kelompok TB sebesar 10 (0-25) mg dan kelompok TU sebesar 15 (0-30) mg (P=0,30). Simpulan: Penurunan MAP dan kebutuhan efedrin pada dosis terbagi tidak lebih kecil secara signifikan dibanding dosis tunggal, namun trend penurunan MAP >20% terjadi lebih lambat dan pemakaian efedrin lebih sedikit pada 3 menit pertama, dengan level ketinggian blok keduanya serupa.

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Background: Injection of a single bolus of local anesthetics in spinal anesthesia is known to cause greater hypotension than a fractionated dose in healthy obstetric patients, but no studies have been performed on obstetric patients with hypertensive complications, especially in Indonesia. Spinal hypotension will interfere to maternal and fetal well-being, particularly to mother with pregnancyinduced hypertension. Objective: Compare the decrease in mean arterial pressure (MAP) and ephedrin requirements, as well as to determine the level of sensory blockade between fractionated dose and single dose technique in spinal anesthesia for Cesarean section in pregnancy-induced hypertension. Methods: Single blinded randomized clinical trials of 42 patients at Tangerang District General Hospital who met the criteria were divided into two groups. The fractionated dose group (TB) was administered by injecting 2/3 of the total doses (1,5 ml) initially, followed by 1/3 of the remaining dose (1 ml) after 90 s. A Single dose group (TU) was performed by injecting all doses in one bolus. Both were performed in a sitting position, using a combination of 0,5% hyperbaric bupivacaine 10 mg and fentanyl 25 mcg (total volume of 2,5 ml), with velocities 0,2 ml/sec, £0,1 ml barbotage before injection, and administration of 5-10 ml/KgBW crystalloids for co-loading. MAP was measured 7 times, as well as ephedrine requirement and level of sensory blockade were recorded. Analysis was performed using a General Linear Model (GLM) test for repeated measurements, Fisher exact and Mann-Whitney U test. Results: The GLM test showed no significant differences between the time measurements between groups (P>0,05), but the line chart showed the TB group's trend of MAP was higher in the first 3 minutes than TU group. MAP decline >20% occured faster in TU group (minute-3). The level of sensory block was mostly at the T4 level of 11 subjects (52,4%) in TB group and 9 subjects (42,9%) in TU group (P = 0,59). The total dose of ephedrine requirement was in median (range) value of 10 (0-25) mg in TB group and 15 (0-30) mg in TU group (P = 0,30). Conclusion: MAP decline and ephedrine requirement in fractionated dose were not significantly smaller than single dose, but >20% decrease in MAP's trend occured more slowly and ephedrine requirement was less in the first 3 minutes, with similar level of sensory block in both groups."

"Trends of cesarean section trend in Indonesia (2007-2012) have doubled the risk of long-term and short-term health problems. This study was aimed to determine relation between antenatal care provider and cesarean section. This quantitative study used cross-sectional design with a total sample of 5,143 women aged 15-49 years who gave birth to the last child through cesarean section or not as in urban areas selected in samples of 2012 Indonesia Demographic and Health Survey. Logistic regression multivariate analysis was used to determine relation between antenatal care provider and section cesarean, which was controlled by maternal age, antenatal care facility, parity, and place of birth. Results showed that antenatal care at obstetrician was 6.6 times higher, while antenatal care at obstetrician and midwife was 2.1 times higher for cesarean section compared to women who had antenatal care at midwife after controlled by maternal age, antenatal care facility, parity, and place of birth. There is interaction between socioeconomic status and obstetrician for a cesarean section. Regulation on cesarean section by health authority, as well as protective and preventive labor applied towards on the high economic class community may reduce unnecessary cesarean section. Trends of cesarean section trend in Indonesia (2007-2012) have doubled the risk of long-term and short-term health problems. This study was aimed to determine relation between antenatal care provider and cesarean section. This quantitative study used cross-sectional design with a total sample of 5,143 women aged 15-49 years who gave birth to the last child through cesarean section or not as in urban areas selected in samples of 2012 Indonesia Demographic and Health Survey. Logistic regression multivariate analysis was used to determine relation between antenatal care provider and section cesarean, which was controlled by maternal age, antenatal care facility, parity, and place of birth. Results showed that antenatal care at obstetrician was 6.6 times higher, while antenatal care at obstetrician and midwife was 2.1 times higher for cesarean section compared to women who had antenatal care at midwife after controlled by maternal age, antenatal care facility, parity, and place of birth. There is interaction between socioeconomic status and obstetrician for a cesarean section. Regulation on cesarean section by health authority, as well as protective and preventive labor applied towards on the high economic class community may reduce unnecessary cesarean section."

"Kami laporkan satu kasus sarcoma Ewing pada ibu jari kaki kiri dengan trans-artikular skip-lesion pada diafisis tulang tibia kiri. Dalam periode 1995-2004 di rumah Sakit Ciptomangunkusumo, telah didiagnosis 20 kasus sarcoma Ewing, namun hanya terdapat satu kasus dengan skip-lesion. Diagnosis transarikular skip lesion pada sarcoma Ewing dikonfirmasi dalam forum clinicopathological conferrence. Riwayat penyakit, pemeriksaan fisik yang cermat dan pemeriksaan laboratorium darah serta foto ronsen toraks dan tulang yang terlibat disertakan dalam evaluasi rutin pasien dengan tumor tulang. Payaran tulang seluruh tubuh dengan menggunakan Tc 99 diperlukan untuk menentukan staging. Pada pasien ini, telah dilakukan amputasi ibu jari kaki kiri dan biopsy terbuka diafisis tibia untuk mengkonfirmasi diagnosis. Setelah itu, pasien menjalani kemoterapi induksi dan kemudian dilakukan amputasi diatas lutut. Pasien meninggal dunia 10 bulan setelah diagnosis ditegakkan akibat metastasis jauh.

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We report the case of the patient who had Ewing Sarcoma in whom radiological and hystopathological appearances revealed a tumor mass in the left big toe along with trans-artikular skip lesion on the left diaphysis of tibia. In Cipto Mangunkusomo Hospital since 1995 until 2004 we have found 20 Ewing sarcoma cases, but only one skip lesion Ewing sarcoma was found. The diagnosis of transarticular skip lesion in association of Ewing sarcoma was confirmed in clinicopathological conferrence. The initial evaluation of all patients included the recording of the medical history, physical examination, and hematological studies. Radiographs of the chest and the site of the primary tumor were made routinely. Systemic staging was performed with use of total-body bone scan. Ray amputation of left big toe and open biopsy from mass of mid-shaft of tibia had been done to confirm the diagnosis. The patient underwent induction chemotherapy and above knee amputation. Ten months after diagnosis, he died because of advanced-distant metastasis."

"Bedah sesarea cendrung mengalami kesulitan dalam melakukan inisiasi menyusui dini karena keterbatasan mobilisasi, nyeri pada bekas operasi yang mengakibatkan tingkat keberhasilan menyusui yang rendah di antara wanita dengan operasi sesarea dan tingkat pemberian ASI eksklusif yang lebih rendah dan durasi menyusui lebih singkat. Penatalaksanaan keperawatan pada ibu seksio sesarea dengan memberikan asuhan keperawatan secara holistik menggunakan action research dan penerapan teori keperawatan. Penerapan teori kenyamanan Kolcaba dan becoming a mother Mercer pada lima kasus breastfeeding self- efficacy ibu seksio sesarea dengan membahas permsalahan yang dialami dan menguraikan peran perawat pada kasus tersebut dengan tujuan kebutuhan kenyamanan dan pencapaian perannya sebagai seorang ibu. Kejadian nyeri post operasi dapat diatasi dengan penerapan evidence based nursing practice pemakaian gurita. Penelitian dilakukan pada lima ibu post seksio sesarea yang mengalami nyeri didapatkan bahwa pemakaian gurita mampu mengurangi skala nyeri secara signifikan dan meningkatkan bounding attachment ibu dengan bayi. Ibu dan suami berperan aktif dalam mengikuti manajemen laktasi.

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Mothers who undergo caesarean sections tend to experience difficulties in initiating early breastfeeding due to limited mobilization, postoperative pain which results in a low success rate of breastfeeding among women with caesarean sections and lower rates of exclusive breastfeeding and shorter duration of breastfeeding. Nursing management for cesarean section mothers by providing holistic nursing care using action research and application of nursing theory. The application of Kolcaba's theory of comfort and becoming a mother Mercer to five cases of breastfeeding self- efficacy of women for cesarean section by discussing the problems experienced and describing the role of the nurse in these cases with the aim of needing comfort and achieving her role as a mother. The incidence of postoperative pain can be overcome by applying evidence based nursing practice using octopus. Research conducted on five post-cesarean section mothers who experienced pain found that the use of octopus was able to reduce the pain scale significantly and increase the bonding attachment between mother and baby. Mothers and husbands play an active role in following lactation management."

"Seksio sesarea merupakan operasi kebidanan terbanyak di RS dr.Suyoto pada tahun 2012 sampai 2014 dengan proporsi 48% dengan indikasi adalah bekas seksio sesarea yaitu sebesar 26,20% kasus. Hasil wawancara diketahui belum adanya clinical pathway seksio sesarea dengan indikasi bekas seksio sesarea di RS dr.Suyoto PUSREHAB KEMHAN. Clinical pathway merupakan salah satu instrumen yang dapat digunakan untuk peningkatan mutu pelayanan, keamanan dan efisiensi pembiayaan. Penilitian ini dilakukan dengan riset operasional deskriptif analitik yang mengidentifikasi aktifitas perjalanan pasien mulai dari karakteristik, administrasi, pra operasi, operasi, pasca operasi, dan outcome pembedahan seksio sesarea.Hasil penelitian didapatkan variasi gambaran karakeristik, aktifitas administrasi, pra operasi, operasi, paska operasi, dan outcome pembedahan seksio sesarea. Berdasarkan hasil penelitian disusun desain awal clinical pathway seksio sesarea dengan indikasi bekas seksio sesarea.

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Caesarean section is the most surgery of obstetric in dr.Suyoto from 2012 to 2014 with the proportion of 48%. Indication majority of 48% of cases cesarean section is previous cesarean section that is 26,20% of cases. Result of interviews, it has not been any clinical pathway of cesarean section with the indication previous cesarean section in dr.Suyoto PUSREHAB KEMHAN hospital. Clinical pathway is one of the instruments that can be used for improvement of service quality, safety and efficiency of financing. This research is done with descriptive analytical operational research to identify activities from the characteristics of patient journey, administration, presurgery, surgery, post-surgery, and surgical outcomes caesarean section.

The results showed variations in the characteristics, administrative activities, pre-surgery, surgery, post-surgery, and surgical outcomes caesarean section with the indications for cesarean section."